Educational Training for Home Hemo

Would like info on the educational texts, videos etc. those of you who are in home hemo were given to prepare for home hemo programs and info on where I could get same. I am not in home hemo yet, but want to prepare. I am working on getting buttonhole sights established and will learn to self stick. I have had to do all this on my own as my unit does not educate unless I ask. I will have to relocate to get into a home hemo program.

I wouldn’t worry about getting info before you start training. I started dialysis in a home training unit and was home after about 17 actual days of dialysis.

Since you are already on dialysis you could start watching how the machine is set up etc., but who knows what machine you will end up with. Each one works differently and is set up differently.

Good luck finding a unit.

My training also lasted 17 days…well, with NxStage machine but not sure with other machines…

Buttonhole videos and such were only allowed for in center viewing…

Just would like to know what ed. materials you used for home training. Don’t know how long it will be before I am in home training. Ready to start learning about it now. Would really appreciate a break down of the ed. materials you used. I will probably be on NxStage or AKSYS.

What you use is the manufacturer’s manual for operating their system which is why you need to know what system you are using first. At least this is what I was taught with, along with simply doing it all yourself (with supervision) from day 1.

Same here, your given the manufactures system manual which technically shows how the machine is setup. Also explains other information but does not explain about buttonhole or other medicine related info…

If your trying to research which machine best fits your needs just shoot away and ask what you wanna know about NxStage/Aksys…well, in a patient perspective view…based on my research…Bill Pecking can answer your questions about Aksys while a few of us here can answer questions about NxStage machine…

How many weeks of training to cover 17 days? I am going to go back and read all the threads to compare machines. But if you can jog my memory, are both AKSYS and NxStage designed for short, daily dialysis? Are there any other advantages considering NxStage is portable and AKSYS is not, does not require water system, does not require waiting to dialyze, less setup and tear down time, takes up less room? Seems like NxStage has more advantages…would you agree?

I do daily and was trained for nocturnal on the Fresenius. I am now doing 5 hour runs 6x a week. So 17 days of training was accomplished in 4 weeks. I think that is pretty usual, about 4 to 6 weeks for training.

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Thanks Gus. Part I am not clear on is what if any advantages does AKSYS have over NxStage?

I don’t understand the NxStage as well as I understand the Aksys PHD. For instance it sounds like the NxStage is limited in the length of runs it can provide, in contrast to the PHD which can provide long runs. I have not seen any clinical reports on the impact of very low dialysate flow rates so I cannot say how two hours of dialysis on the NxStage would compare to two hours of dialysis on the PHD. There must be more supplies to store for the NxStage v. the PHD.

The thing the PHD is designed to do well is prevent Hypersensitivity Reactions (this relates to another thread on this Board). Both machines use ultra pure dialysate which I think will prove to be a big advantage over standard machines; I think the PHD goes further to minimize chronic inflammation reactions. As Gus pointed out in the other thread by reusing the F-80 dialyzer and the blood tubing set the Aksys allows a protein coat to build up on these surfaces. The protein coat minimizes the inflammation response because the surfaces coated with protein appear natural.

The blood tubing that the PHD uses is more durable and wont degrade as compared to standard blood tubing but I don’t know how it compares to the NxStage’s blood tubing. The Aksys also infuses ultra pure dialysate (UPD) instead of saline and it infuses UPD during treatment – a process called backflushing – which I think increases convection: waste moves across the membrane through both diffusion and convection which should lead to greater middle molecule clearances. Between the convection and the higher dialysate flow rates I would think that the PHD gives better clearances per time on the machine but I have not seen any clinical studies of the NxStage so this is just my speculation.

I don’t understand the NxStage as well as I understand the Aksys PHD. For instance it sounds like the NxStage is limited in the length of runs it can provide, in contrast to the PHD which can provide long runs.

NxStage is capable of longer runs…right now I know 2 patients running it at 4 hours and 5…one of the patients does it every 2 days for 5 hours…

I have not seen any clinical reports on the impact of very low dialysate flow rates so I cannot say how two hours of dialysis on the NxStage would compare to two hours of dialysis on the PHD. There must be more supplies to store for the NxStage v. the PHD.

The flow rates are adjustable on NxStage…for instance I have it adjusted for 15 liters within 2.5 hours…now supplies for NxStage is quite a bit…especially the pre-mixed dialysate bags…I barely was able to store a whole month of supply in my closet and hall corner, but also have the option of getting supplies every two weeks…

The thing the PHD is designed to do well is prevent Hypersensitivity Reactions (this relates to another thread on this Board). Both machines use ultra pure dialysate which I think will prove to be a big advantage over standard machines; I think the PHD goes further to minimize chronic inflammation reactions. As Gus pointed out in the other thread by reusing the F-80 dialyzer and the blood tubing set the Aksys allows a protein coat to build up on these surfaces. The protein coat minimizes the inflammation response because the surfaces coated with protein appear natural.

Would be interesting for me to give Aksys a trial drive in center just to see how my body reacts to both machines…

The blood tubing that the PHD uses is more durable and wont degrade as compared to standard blood tubing but I don’t know how it compares to the NxStage’s blood tubing. The Aksys also infuses ultra pure dialysate (UPD) instead of saline and it infuses UPD during treatment – a process called backflushing – which I think increases convection: waste moves across the membrane through both diffusion and convection which should lead to greater middle molecule clearances. Between the convection and the higher dialysate flow rates I would think that the PHD gives better clearances per time on the machine but I have not seen any clinical studies of the NxStage so this is just my speculation.

Because Aksys had a headstart in its technology the data is already there but I think NxStage is still gathering data in this study so it will not be soon enough that such data will be made public. However, both machines are intended for short daily home use so I think the outcomes most likely will be the same but only what will differ are the tech specs on how they work

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So that is 15 liters over 150 minutes or 1 litter every 10 minutes (thanks for using numbers that makes for easy math). With a dialysate flow of 1 litter every 10 minutes that is equal to a dialysate flow of 100ml per minute. Until the NxStage I had never heard of dialyzing with a dialysate flow rate that low. Are the people running 4 and 5 hours using 5 and/or 6 bags of dialysate or are they running at even lower dialysate flow rates? What blood pump speed do you run at?

When I first started on the Aksys there was a maximum run length of 170 minutes and the dialysate was set for single pass which meant that the dialysate flow rate was around 280 ml/minute. One of the things that has evolved over time is that the maximum run length has increased - I’ve done eight hour + runs - and now the dialysate flow rate is calculated by the machine based on, I believe, the blood pump speed. I think there was a an issue that at low blood pump speeds and high dialysate flows (800 ml/minute) there was an ultra-filtration error. In any case the machine now calculates the dialysate flow rate and it is always greater than the blood pump speed.

There was a discussion on the Dialysis_Support listserv a number of years ago. Jim Boag a technical expert posted that for optimal results ones dialysate flow rate should be twice ones blood flow rate. I thought this was a function of fluid dynamics. It will interesting to hear if there is a difference when someone gets to try both machines. My hope is that my center will offer the NxStage for vacation use, making it available to home hemo patients (that’d be a great carrot to get people into home hemo).

Jane I agree with what Cathy said in regard to learning a particular machine but you could learn to self cannulate from the start and there is a video available for that. Here is a link to info from the Dialysis_Support listserv on the buttonhole technique and there is an address for ordering a video:
http://members.dancris.com/~dalee/btnhole.html
The info is likely older than the info available from Home Dialysis Central but I think the address for the video is still good.

No matter which machine you use or which methoid of hemodialysis you choose learning to self cannulate is the number one thing you can do to make dialysis easier. It makes incenter dialysis less stressfull and it identifies you as someone who is taking charge of their treatments and care. Sticking yourself is the way to go, I can not think of a downside.

So that is 15 liters over 150 minutes or 1 litter every 10 minutes (thanks for using numbers that makes for easy math).

Number, numbers, numbers…hehe

With a dialysate flow of 1 litter every 10 minutes that is equal to a dialysate flow of 100ml per minute. Until the NxStage I had never heard of dialyzing with a dialysate flow rate that low. Are the people running 4 and 5 hours using 5 and/or 6 bags of dialysate or are they running at even lower dialysate flow rates?

Not sure about their parameters but they definately use up to 20liters or more…

What blood pump speed do you run at?

I do 370-410…410 is about the highest my body can tolerate

When I first started on the Aksys there was a maximum run length of 170 minutes and the dialysate was set for single pass which meant that the dialysate flow rate was around 280 ml/minute. One of the things that has evolved over time is that the maximum run length has increased - I’ve done eight hour + runs - and now the dialysate flow rate is calculated by the machine based on, I believe, the blood pump speed. I think there was a an issue that at low blood pump speeds and high dialysate flows (800 ml/minute) there was an ultra-filtration error. In any case the machine now calculates the dialysate flow rate and it is always greater than the blood pump speed.

I think very high blood pump rates is damaging to the nervous system…after 10 years or more you’ll notice nerve damage…such things like carpal tunnel…believe me, gentle dialysis is the way to go and not ultra-fast pumping…

There was a discussion on the Dialysis_Support listserv a number of years ago. Jim Boag a technical expert posted that for optimal results ones dialysate flow rate should be twice ones blood flow rate. I thought this was a function of fluid dynamics. It will interesting to hear if there is a difference when someone gets to try both machines. My hope is that my center will offer the NxStage for vacation use, making it available to home hemo patients (that’d be a great carrot to get people into home hemo).

I agree that it would be a nice research trying both machines…how about you going on NxStage and I go on Aksys for a month trial… let’s trade places!!..hehe, :lol:

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Sure blood flow but I’m wondering about low Dialysate flow rates on the NxStage. I’ve never heard of dialysate flow rates that low. I thought there were issues with low dialysate flow rates.

OMG a new Fox reality TV show!! I’m in… We need a catchy name… Extreme Trading Spaces…and a Host - maybe bring former Surgeon General C. Evert Koop out of retirement…it’s always good to have a host with a three part name and he would come with his own uniform.

I did a Pub Med search and found:

In vivo effects of dialysate flow rate on Kt/V in maintenance hemodialysis patients.
by Hauk M, Kuhlmann MK, Riegel W, Kohler H. published in January 2000 in the American Journal of Kidney Disease.

The paper reports that dialysate flow rates have a significant impact on clearances. I’d have to say dialysate flow rates would be the biggest difference between to the two machines. The PHD is running me at a dialysate flow rate (Qd) of 800 ml/min right now as I write this, with a blood flow rate (Qb) of 350.

At an 800 Qd the Aksys is reusing its 50 litter supply of dialysate - it goes through its tank about once an hour. So on the one hand the solute differential between the blood side and the dialysate side narrow every hour but it looks to me like the impact of a slow dialysate flow rate is more significant.

I am basing this on the above cited article summary and another article I found online: Effect of Dialysate-Side Mass Transfer Resistance on Small Solute Removal in Hemodialysis by William R. Clarka and James H. Shinabergerc which is from 2000 too. This article also points out changes in dialyzer design impact how dialysate flows through the kidney, and across the membrane, so I imagine one could design a kidney for a slow Qd. It will be interesting to see NxStage’s clinical results. Which kidney do you use Gus?

What I am wating to know is, other than the machine manual, were you given any other written materials or videos to study for home training?